The nature and treatment of stuttering as revealed by fMRI A within- and between-group comparison

This article reviews some of our recent functional magnetic resonance imaging (fMRI) studies of stuttering. Using event-related fMRI experiments, we investigated brain activation during speech production. Results of three studies comparing persons who stutter (PWS) and persons who do not stutter (PWNS) are outlined. Their findings point to a region in the right frontal operculum (RFO) that was consistently implicated in stuttering. During overt reading and before fluency shaping therapy, PWS showed higher and more distributed neuronal activation than PWNS. Immediately after therapy differential activations were even more distributed and left sided. They extended to frontal, temporal, and parietal regions, anterior cingulate, insula, and putamen. These over-activations were slightly reduced and again more right sided two years after therapy. Left frontal deactivations remained stable over two years of observation, and therefore possibly indicate a dysfunction. After therapy, we noted higher activations in persons who stutter moderately than in those who stutter severely. These activations might reflect patterns of compensation. We discuss why these findings suggest that fluency-inducing techniques might synchronize a disturbed signal transmission between auditory, speech motor planning, and motor areas.

Educational objectives: The reader will learn about and be able to: (1) identify regions of brain activations and deactivations specific for PWS; (2) describe brain activation changes induced by fluency shaping therapy; and (3) discuss the correlation between stuttering severity and brain activation.     

The Guilty Knowledge Test and the modified Stroop task in detection of deception: an exploratory study

The current study tested whether a simple Stroop paradigm can be used to detect deceptive behavior. 40 university students (34 women), half of whom committed a mock crime, were administered a Guilty Knowledge Test and modified Stroop task to detect guilt or innocence. The Guilty Knowledge Test is a well-known psychophysiological detection method, which consists of multiple-choice questions about details of the crime while skin conductance is recorded. Subjects possessing guilty knowledge are expected to show enhanced differential responses to the relevant stimuli. The modified Stroop task required color-naming of colored words related to the mock crime or an irrelevant crime. Each version of the Stroop task was presented in story form. Subjects possessing guilty knowledge were expected to produce larger reaction times to the relevant version relative to the irrelevant version. The test correctly identified 100% of innocent participants and 78% of guilty participants. In contrast, Stroop interference. i.e., reaction times for irrelevant crime details subtracted from those for mock crime details, did not differentiate between the two groups, suggesting that the story form of the Stroop paradigm is not suitable for lie detection.     

Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network

This study sought to investigate the following research questions: Are time-limited day treatment programs for patients with personality disorder (PD) effective outside resourceful university settings, and what are the overall treatment results when the program is implemented on a larger scale? Do all categories and subtypes of PDs respond favorably to such treatment? How intensive should such day treatment programs be? All patients (n = 1,244) were consecutively admitted to eight different treatment programs in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2000. Altogether, 1,010 patients were diagnosed with PD. Avoidant, borderline, not otherwise specified (NOS), and paranoid PD were the most common conditions. SCID-II and MINI were used as diagnostic instruments. Outcome measures included GAF Global Assessment of Functioning, (GAF; American Psychiatric Association, 1994), SCL-90R, CIP, Quality of Life, work functioning and parasuicidal behavior, measured at admittance, discharge and 1-year follow up. The attrition rate was 24%. The number of dropouts did not improve over time. As a group, completers with PD improved significantly on all outcome variables from admittance to discharge and improvement was maintained or increased at follow up. Treatment results were best for borderline PD, cluster C patients, PD NOS and No PD, and poorer for cluster A patients. Units with a high treatment dosage did not experience better outcomes than those with a low treatment dosage (10 hours per week). Results from the University unit were not better than those from units at local hospitals or mental health centers.     

Boundary distortions for neutral and emotional pictures

In two experiments, we examined Safer, Christianson, Autry, and Osterlund's (1998) claim that when emotional material is remembered, tunnel memory (i.e., the tendency to remember less of a scene than was actually shown) occurs. In Experiment 1, 81 undergraduate students drew photographs from memory after having briefly seen either four neutral or four emotional photographs. Both neutral and emotional drawings revealed boundary extension (i.e., the tendency to remember more of a scene than was actually shown). Experiment 2 relied on the camera distance paradigm (Intraub, Bender, & Mangels, 1992). In a recognition test, 60 undergraduate students judged the camera distance of previously seen neutral or emotional photographs. The majority of them demonstrated accurate judgments and neither extended nor restricted picture boundaries. Those participants who made an error more often displayed a boundary extension than a tunnel memory error. Taken together, our results suggest that boundary extension for neutral and emotional photographs is a more robust phenomenon than its counterpart, tunnel memory.     

Children's nighttime fears: parent-child ratings of frequency, content, origins, coping behaviors and severity

The present study investigated nighttime fears in normal school children aged 4 to 12 yr (N=176). Children and their parents were interviewed about the frequency, content, origins, coping behaviors and severity of children's nighttime fears. Results showed that 73.3% of the children reported nighttime fears, indicating that these fears are quite prevalent. Inspection of the developmental course of nighttime fears revealed that these fears are common among 4- to 6-year-olds, become even more frequent in 7- to 9-year-olds and then remain relatively stable in 10- to 12-year-olds. Inspection of the origins of nighttime fears revealed that most of the children (i.e., almost 80%) attributed their fear to negative information; conditioning and modeling were endorsed less frequently (25.6% and 13.2%, respectively). A substantial percentage of the children (24.0%) indicated that learning experiences had not played a role in the acquisition of their nighttime fears. Children reported a variety of coping strategies in order to deal with their nighttime fears and generally rated these strategies as helpful in reducing anxiety. Furthermore, children's nighttime fears were associated with moderate levels of anxiety. Moreover, in about 10% of the children, nighttime fears were related to one or more DSM-III-R anxiety disorders. Finally, parental reports of children's nighttime fears substantially deviated from children's reports. Most importantly, parents provided a marked underestimation of the frequency of nighttime fears, at least as reported by their children.     

Thought-action fusion as a causal factor in the development of intrusions

Thought-action fusion refers to the tendency to treat thoughts and actions as equivalents. Some authors (e.g., Rachman, 1997; Behaviour Research and Therapy, 35, 793-802) have suggested that thought-action fusion plays a role in the etiology of obsessive intrusions. The present study sought to test this idea. Subjects (n = 19) in the experimental condition underwent a bogus EEG recording session. They were informed that the apparatus was able to pick up the word 'apple' and that thoughts of that word could result in the administration of electrical shocks to another person. After having spent 15 minutes in the EEG laboratory, experimental subjects and controls (n = 26) completed a short questionnaire containing items about characteristics of the target thought (e.g., frequency, aversiveness). Results indicate that thought-action fusion, indeed, promotes intrusive thinking in that it results in a higher frequency of target thoughts, more discomfort, and more resistance. Thus, the current findings support the idea that thought-action fusion may contribute to the development of obsessive intrusions.     

Psychopathological correlates of self-reported behavioural inhibition in normal children.

The present study examined the relationship between self-reported behavioural inhibition and psychopathological symptoms in a sample of 152 children aged 12-14 years. Children were provided with a definition of behavioural inhibition and then asked to classify themselves as low, middle or high on behavioural inhibition. Furthermore, children completed questionnaires of worry, depression and anxiety symptoms. Results showed that children who endorsed the high behavioural inhibition category had elevated levels of anxiety, worry and depression compared to children who endorsed the low or middle behavioural inhibition categories. Moreover, children high on behavioural inhibition more frequently reported anxiety disorders symptoms in the subclinical range. These findings fit well with those of previous studies on behavioural inhibition.     

Mobilization of Cognitive Resources and the Generation Effect

The generation effect refers to the memory advantage of words that have been generated rather than read. Such a read-generate comparison confounds qualitative task differences and raises methodological problems. A revised methodology is proposed circumventing these problems in that the encoding task is held constant and all stimuli have to be generated, but the degree of generativeness (i.e. the amount of cueing) is varied. In Experiment 1, 1, the (refined version of the) generation effect is demonstrated in a within-subjects design; with increasing generation activity left to the subject, free recall performance increases. No effect is obtained for degree of target masking. The same finding is replicated and shown to be independent of self-paced study time when generative activity is manipulated between subjects (Experiment 2) or within subjects (Experiment 3). As all learning trials involve generation, encoding time is controlled statistically, and free recall is used as a measure of memory, this refined generation effect cannot be explained as an artifact of selective attention or elaboration. Rather, generative activity seems to increase the mobilization of cognitive resources. This motivational account is supported by Experiment 4 showing an enhanced generation effect for positive mood.     

Two-year follow-up of an interdisciplinary cognitive-behavioral intervention program for obese adults

Intervention programs for treating adiposity which focus on dietary change and physical exercise often do not lead to the desired long-term reduction in weight. This article reports on the effectiveness of M.O.B.I.L.I.S., a standardized theory-driven intervention program. Participants are taught cognitive-behavioral strategies of goal setting, action planning, barrier management, and self-monitoring. Persons with obesity (N=316) responded to a public advertisement to participate in the intervention program (IG) or comparison group (CG; quasi-experimental design). Assessments were conducted at four time points, with the last assessment being conducted two years after baseline. At the 24-month follow-up, the IG showed weight loss of 5.57%, whereas the CG lost 1.12% of their weight (t1-t4, p < .01). The results yielded significant interaction terms (group x time), indicating that the intervention had a substantial effect on food choice and level of physical exercise (p < .01). The IG showed significantly enhanced self-efficacy, stronger goal intentions, and more detailed implementation intentions than the CG at follow-ups. The intervention program has the potential to evoke enduring changes in the cognitions we hypothesized to be responsible for inducing obese adults to begin and continue regular exercise and healthy eating behavior, resulting in substantial weight loss.     

Anterior cingulate cortex activation is related to learning potential on the WCST in schizophrenia patients

The remediation of executive function in patients with schizophrenia is important in rehabilitation because these skills affect the patient's capacity to function in the community. There is evidence that instructional techniques can improve deficits in the Wisconsin Card Sorting Test (WCST) in some schizophrenia patients. We used a standard test/training phase/standard test format of the WCST to classify 36 schizophrenia patients as high-achievers, learners or non-retainers. All healthy controls performed as high-achievers. An event-related fMRI design assessed neural activation patterns during post-training WCST performance. Patients showed a linear trend between set-shifting related activation in the anterior cingulate cortex and learning potential, i.e. increased activation in high-achievers, a trend for increased activation in learners, and no activation in non-retainers compared to controls. In addition, activation in the temporoparietal cortex was highest in patients classified as learners, whereas in non-retainers activation was increased in the inferior frontal gyrus compared to controls and high-achieving patients. These results emphasize the relevance of the ACC's neural integrity in learning set-shifting strategies for patients with schizophrenia. Also, our results support the hypothesis that compensatory neural activation in patients with schizophrenia helps them to catch up with healthy controls on cognitive tasks.